Finding the chase and cutting to it

I love reading, but just fiction wanes after a few days. So, I’ve been catching up on some type 1 diabetes literature.

The American government is particularly keen on publishing papers, and Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association caught my eye.

One of the difficulties we have in replacing our insulin requirements with externally provided insulin is that’s only half the story.  Insulin production in humans is couple with C-peptide release, which shuts off glucagon production in the alpha cells of the Islets of Langerhans.

However, quite a few type 1s retain this ability, for as long as 40 years after diagnosis.  Only it’s not a constant, guaranteed rate.  If we imagine that my body, like yours, is still producing beta cells but, unlike you, then systematically destroying them – this makes sense.

But leaves us with an impossible conundrum – how much insulin do we need day to day?  “Madness is doing the same thing every day and expecting different results” is attributed to Albert Einstein.  With type 1, doing the same thing every day can lead to wildly different outcomes.

Hell, no wonder you sit there frowning at your meter!

Rude, that’s just rude  But yes, it is not always trivial.

Many see hybrid pumps as being the answer – I have to say the past few days, it has actually helped.  But that’s because I haven’t been eating and things have been crazy with my infection.   Who knew that’s what it would take to get it doing reasonable things?

Not eating is not a long term viable option though (my results when travelling into London have been helped a great deal by taking this approach, so short term: it’s fine).

One of the other things that’s been interesting with the articule has been the approach to care.  When I moved away from Ipswich, I found most GPs liked to “manage my diabetes” which was a different approach to the one I’d had in Ipswich, where the focus was training to allow us to make adjustments ourselves day to day and check it’s working every 12 to 6 months.

In my various type 1 groups, those of us who do better seem to be the self-managers. Long term. Surely if the numbers support this, that’s what every clinic and GP should be looking to do?

I did a maths degree and computer science because I love the synergy of what can be done with number processing.

Computers can chew through series without pausing to take a breath: what’s not to like?

While I’m physically laid up, and 45 minutes playing with these numbers, I am shattered – I am supposed to be going back to work on Wednesday…

Focus! Why are we here today?

Good point. I’ve pulled out our smart meter data, and it makes interesting reading:

I’ve enclosed the graph of the electricity and gas consumption against our electricity production.

Now, this data is looking at the full 90 days available to me, though I might start just pulling off calendar months…

We can see here that while we are consuming electricity, we are also producing (and donating) electricity. Though at vastly different rates.

In our case, that production is from our solar cells and are car donating electricity into the grid.

The only way we can tell which is which is by comparing our solar and V2G logs.

We are not in Kansas any longer, Dorothy. Imagine how complex this gets once you combine in microgeneration from combined heat and power units or from wind turbines…

That’s not to say what the UK is doing is not very sane in terms of getting consumers to group together with feed in tarrif payments and buy-in subsidies. Since these have disappeared, of course, and prices have climbed, many more people are looking at batteries and other power storage mechanisms such as heating hot water (we’re doing this with a Solar iBoost).

Yawn…

Actually, Tonto, this might be one of the more interesting of the things I talk about here.

If we want to keep our energy targets and reduce global warming, this kind of thing becomes very interesting. Simple choices, such as cooking by microwave (last week, I used dramatically less electricity by cooking from scratch in the microwave). We all have a part to play and it doesn’t have to be by expecting other people to tell us what decisions we need to make.

This data is available – what can you do with yours?

I’m unwell.  I run a low body temperature, but when my body was doing everything it could to generate a fever on Tuesday, I took the hint, so while the body is weak, the mind is racing.

Type 1 diabetes means that all the mechanisms my body is relying on to get a fever are being over-riden by my desire to not die early, develop a blood clot (resulting in stroke, blindness, septicemia, or a heart attack), or diabetic ketoacidosis – which is a ticket to a hospital ward and a reasonable question of “what went wrong?”.

So it takes much longer to develop a fever and kick an infection to the line.

But type 1 is “just type 1 diabetes”, everyone knows that’s what happens when we’re sick 😉

What are you whinging about now?

Just that, we’re not that usual.  Rare disease day is coming and I was a little curious about what makes something a rare disease.  Aren’t you?

I guess, but your thing definitely doesn’t count!

That was my thought.  But this is a question of scale.  I’m one of around 8·4million in the world with type 1 with type 1 diabetes in 2021 (best confirmed numbers) against a world population of 7.888 billion (a 1000 million).  That means an prevalance of 0.106% of the world’s population or 10 of us per 10,000.

So, we’re not that far off meeting the World Health Organisation’s definition – an incidence of 6.5 (or less) per 10,000 or 0.065% of the population.

I’m a bit of a numbers geek, and as I said, it is all about scale.

Let’s look at Europe as per The US Government’s National Library of Medicine, Prevalence and incidence of Type 1 diabetes in the world, 2020, Table 2.
Only one place in the world where type 1 has a higher prevalance of 6.5 people per 10,000 in the world and that’s in Asia.

In my humbe Europe, we only count for 2.12 people in 10,000.

The numbers fall down when we look at the UK.  We have around 7.5 people per 10,000.  Common as muck 😀  Though in Scotland, that rises to 22!

Which is a bit surprising.  And also leads us to the definition of what type 1 is.  An autoimmune condition causing destruction of the beta cells.  Not someone who needs insulin to treat their diabetes.

This might seem petty but it is really important because insulin treatment can be a progression for type 2 diabetes though a sustaintially different and complex condition in its own right.

Those taking insulin (or prescribing it) are not necessarily the best people to ask.

Which leads us naturally to the fact there are three kinds of lie: lies, damned lies, and statistics – Mark Twain.

But no, unusual but not rare for the 29th January.

In 1989, the then Conservative government brought in a poll tax. Rather badly as it happened as couples with a stay at home parent often had a much larger council tax bill each year – indiscriminantly, so the less well paid workers were hit hardest. In May 1991, the tax was abolished and a property valuation tax was introduced instead.

Personally, I like the idea of a tax you actually get to choose, but no further valuations of property have happened since 1991 – so we have bizaare cases where extended houses, which have a bigger impact in terms of waste generation and consumption of services may be paying very little to contribute.

Property valuation is also subject to interpretation.

I’d quite like to see a footprint tax, one that encourages the use of smaller properties by responsible owners. It is much easier to build a highly efficient property in terms of water and energy use if the property is smaller.

So, the first measure should be habitable space in the property. I think our council tax is about right and our house is 244m², so shall we shall £12 per square metre?

The next measure is the ground space – how big is the plot and how much is laid to garden? Our plot is about 793m² and about a third is lain to garden. Let’s say the house is 122m², so that’s an available plot of 671m² and about a third is lain to garden – that’s 115m² – we need more soak aways and carbon sinking ground, so that’s charged at £1.50 per metre squared. The remaining 556m² should be at a higher rate, so £3 per unit.

We should then do an environmental disturbance discount – we pay a grade lower for our house because we live on the busy ring road. Say, 15%. Railways, roads, etc should allow be taken into consideration because this is vital infrastructure to keep the country moving.

So:

• House = 244*£12= £2,928.
• Garden= 115*£1.50=£172.50.
• Non-habitable, driveways, etc = 556*£3 = £1,668.

Total = £4,768.50.

Apply the discount for the ring road, and we get £4,053.23. This is about a £1,000 per annum more than we’re paying at the moment but this took me 10 minutes to calcuate and seems relatively fair, it seems representative of our impact on the world. If we built an extension, it is easy to calculate the footprint and add that to our council tax bill. In fact, you could automate that with planning applications.

The average house in the UK is 80m² in urban areas and 123m² in rural areas. The average garden is about 140m² in London and 190m² in rural areas, though modern builds it is much closer to 120m², with two thirds laid down to garden.

The average family in a city would therefore pay £1,240 and in the country £1,856. We live in Ipswich, and an average home is deemed a Band D – £2,154.69. So this works out at just under £300 pa less, though I think in Ipswich there could be a great deal of difference between some small band Ds and some larger, extended ones.

An average house in a city is less likely to have a garden, so the flat owners would have a smaller bill. They are less likely to have off road parking, etc.

Isn’t it unfair if you build an extension which doesn’t go into a garden, like a loft conversion?

I’m going to throw that back to you: you convert the loft into habitable space, what are you doing to keep it habitable? You have things in there, heating, lighting, windows, flooring, etc. Things all have costs in terms of environmental impact and the extra living space will be used by the next people who live in the house. Which is likely to drive up environmental costs and potentially service costs.

One that chews up garden is going to need foundations, is removing soak-aways – that cost is bigger, but you are losing space outside. Let’s say you build an attached garage with a room above it – the garage could be charged at £3 per metre squared and the room for £12 per metre squared – you would only be billed the extra for the extra space.

One of the beauties about this is the council tax bill is equivalent across the country – a small house in London (and many properties in London are small as there is a finite space and people who want to live there) would pay less than a big house in the country even though the cost of the properties is likely to be similar. London council would still have a fortune coming in, because there are millions of households. Council’s across the country would have an easy way to calculate their budgets because they know how much habitable space is in there boundaries. Much more importantly, when people extend small houses, removing them from the housing stock, the council can easily get the money from those changes.

We’re in the barmy situation where living in Ipswich is a larger house is significantly cheaper than living in the country where we’re paying a “rural tax” for some services. Our council tax bill for a house that is 80m² bigger is £750 on average less a year!

You could even link up the EPC to help: an EPC is generated each time a house is sold if not every 10 years. They do measure the living space, as this is a key factor in determining how energy efficient a house is.

What about discounts for sole living and empty houses?

Because of the lack of housing stock, the “empty house” rebate is no more.

But what about sole living? If my husband died and my son moved out, I am living in 244m² house on my own.

I do think it’s different if you have dependent children and perhaps there should be a discount in that case, especially in the case of death. But we have families living in small accommodation when rich people get to live in large houses: shouldn’t there be a redistribution of wealth if we’re not getting family houses being freed up?

Council tax is the only tax you choose the rate at which you pay. Shouldn’t what you pay be determined by what you have chosen to live in?

Of the holiday season, New Year’s Eve is my favourite day and I still have to wait one whole day for it.

Having had the feast on Christmas Day (turned out really well, despite some miscommunication), and cleared it and the left overs away (final meal today, largely thanks to visiting friends and relatives), I consider what I would like to happen next year.

I don’t make resolutions. I do set targets of what I think I’d like to look back on and think “I did that” this time next year.

This doesn’t mean the plans are unfolded in January – on 31st Dec 2005 I decided I was going to learn to ride a motorbike. It took until April to save up enough to buy a small bike, so that’s when consolidation happened. The next year, I decided to learn the piano (like the motorbike, not something you completely achieve in a year) and started by buying a descant recorder on the basis that was significantly cheaper and if I didn’t stick with it, a piano was not a reasonable thing to get.

I bought my electric piano in June. It cost less than the motorbike and I got to grade 4 over the next 5 years.

It’s very hard not to just focus on clearing the mortgage, because that shouldn’t take the whole of 2024. It’s a notable achievement but a bit empty, if you know what I mean.

I normally try to think of something I’d like to be able to do, somewhere I’d like to travel, and something that would help enrich my life. I appreciate that for many the first two items would do that, but I’m talking more about the day to day things that make life easier or bring a smile to my face.

On New Year’s Eve 2017, we made the decision to put in fitted units to our bedroom and facilitate reorganising our ensuite for example. Thanks to lockdown, the ensuite wasn’t done until 2021, but the task was significantly easier thanks the groundwork undertaken in 2018.

Of course, being in a partnership, it’s not just about me. My husband is looking at building a path to our back fence and inserting a gate so we can walk and get our paper on a Sunday more easily. This should be an easy task but the fence is a little unusual being completely custom. Which may mean completely replacing the fence.

A year long task, perhaps?

BSL has become a GCSE option, so I could do some groundwork on that. Our niece has moved from America to the Netherlands, so that’s somewhere to go… Happy New Year x

Monday all went without a hitch. The bird went in to the second of the right time and came out duly. As my beloved husband was doing the potatoes, he did not feel the need to tell me when, so I did forget to take the foil off at the wrong time and he didn’t put the top (non-fan) oven on the right temperature, but all in all, it went without a hitch.

I know many do not see the point of a turkey, and if it were just my husband and I, I wouldn’t. A small goose or large duck would make a magnificient feast for two. But we had four omnivors and one vegetarian, so it was lovely to have something different.

I even like the left overs, though I work hard to ensure nothing is kept for more than 5 days. Next week, we won’t be eating much, having feasted all week.

And that was the whole point. The midwinter’s feast was the last of the vegetables from summer and the first meat kill from the farm stock. The people alive today are geared towards having periods of fasting – we even geared many of our religious festivals around it. Like Christmas and Easter in Christianity and Ramadan in Isalm.

Modern farming gives us a delemma, as do many cookery programmes and ready meals. We’re not meant to feast once a day, every day.

During a normal week, I eat lean. 20g of carbohydrate for breakfast (either juice or yogurt), 40g for lunch (typically one sandwich and water) and 50g for tea (main meal of the day, a feature starch – pasta, rice, or potatoes and vegetables and protein).

The weekend is typically two meals a day, a snack and a big meal with 60-80g of a starchy carbohydrate, 60-80g of protein source, and sauce and vegetables. Bread for the snack or soup without anything else: my soups are vegetable based, so extra starch is not a necessity.

I don’t know if this is usual, but it works for us. We eat more in the summer, when we’re physically more active and then cut down as mid-winter comes. I like to exercise outside, so the cold and wet is not conducive to building up a sweat! I do belong to a gym, but while I do enjoy the endophin high, getting me and my gear over there is not always going to happen when a 15 minute stroll into town is much more enjoyable, especially with company.

Normally, I don’t take that much time off work at Christmas, preferring to save my leave allowence for a skiing trip in January or early February. This year, we are giving it a miss in favour of taking that money off our remaining mortgage. We’re paying half our take home in order to clear the mortgage early. We were very lucky that mortgage rates only went up when our mortgage was nearly finished, but there is no point frittering money when the end is in sight.

Looking at it a different way, we’re living lean on the food scale and the life scale while it is comfortable to do so without huge scarifice – a winter holiday is not an essential on anyone’s list who doesn’t professionally ski for a living.

The house is warm and well cared for. I have clothes to last for the next couple of years. Once mortgage is paid off, our expenses are only 15% of our earnings – that’s food, land tax (we call that council tax in the UK), transport, heating, water, and electricity for cooking and washing clothes.

We replaced many of our appliances over the past three years and the last two rooms in the house to need major work are the family bathroom and the kitchen. The windows do need replacing. The current plan is windows first, then bathroom, and finally the kitchen.

The hope is we don’t ever have to borrow again.

Which means building up a six month salary savings pot (which should cover 3 years of being unemployed with careful budgeting), then doing the major work for the house off savings. Good grief, that sounds grown up and sensible!

As that’s the plan, I’d better start doing rather than talking. Happy 2024.

Caught up with an old friend today but took a bit of a risk and cooked something relatively new.  Which is always a bit scary not least when you’ve kind of insisted on it (makes my life a bit easier).

To make some much needed space in the fridge, I’d already decided to cook a Spaghetti alla Carbonara before I’d known about my friend coming over, so a quick check on quantities, and the plan is on.

But working out a recipe while being company needs a bit more prep than normal.  Before anyone arrived, I measured out my portions and ingredients and kept things in the fridge.  I filled the pan with water for the pasta, weighed out the butter for the Carbonara and for the brandy butter on Monday and realised that the order I’d picked up on Wednesday for Christmas day was lacking a Christmas pudding.

Get back to the original story!

Sorry, yes, prep.  Having sorted everything out for Monday (my beloved popped out to source a pud), when Jon got back, I started the cooking.

And it did work amazingly well.  I did stop talking, I am not someone who can cook and make interesting conversation, in fact the concentration it requires from me is one of the joys I find in cooking, but I cooked something very edible.

Of course, this is glossing over the fact I screwed up chopping up the bacon, I forgot to put on my apron so Jon helped to dress me.

But food was served that was enjoyed.

So there have been a number of changes in our life, not least the amount of cooking we’re doing at home.

Which opens opportunities. Not least in terms of planning in three big areas: reducing waste, reducing waist, and reducing cost.

I’m 171cm tall as an absolute max – that is first thing in the morning before gravity takes its toll. Largely, I work in an office sitting at a desk, like my husband and son. This means I don’t need more than 1400 calories a day. This is significantly below the 2000 that are recommended for women, but mostly these guidelines are against people having very active lives – but I am a desk jockey, not a racing jockey.

So, how can I ensure I eat enough vitamins and minerals, protein and fat, and carbohydrates without busting that 1400 calories a day?

The trick is measured portions, drinking water if thirsty, and keeping it real. We eat a big meal on a Sunday, so Sunday breakfast and tea or small.

My freezer is invaluable for only cooking what you need – things like pastry is faff to make in smaller doses, taking out half or a quarter and dividing up the remaining lots for use a few weeks later.

Left overs are a big deal. I did a Christmas honeyed ham this lunchtime, 1.6kg of pork is way too much for three people in a sitting, so this evening Jon and I are having fresh bread and ham sandwiches. Our son is doing himself bubble and squeak with cold ham and fried eggs.

Next week, the last of the ham will be combined with left of turkey in vol au vents with peas and sweetcorn. Quick, easy, and delicious.

Commercial ready meals show that a small amount of meat goes a long way in things like combined stews and pies. Vol au vents are a great example of this too. Stir fries combining meat with veggies is the final trick.

We’re (hopefully) getting a small enough turkey to give a great Christmas feast and one meal for four people and two – three meals for three people.

Pastry, pasta, and rice are all friends to consider. And of course, we’ll have some herbs, vegetables, complementary tastes.

Now that’s all coming together as a plan, and the tree is up, I’m wishing you all a very Merry Christmas and a Happy New Year.

I love Christmas, but before the glorious 12th, I’m a bit down. This is a little new because I didn’t know my diagnosis date for certain for many, many years, but I knew it was around this time before Christmas.

I know it’s a bit strange because this all happened a long time ago, 46 years this year. For the first time, I’m taking the day off work to attend a charity function – not for type 1, but interesting all the same. I have plans for most of the days that week – keeping my mind off it.

Unusally, this year, it’s actually cold: below freezing, which is notable in the UK. We had snow yesterday.

I’ve downloaded my favourite cooking show, my husband has lit a fire, I’ve closed the curtains, grabbed my oody and I’m settled, while my dough rises to make bread rolls. These will not only complement my carrot and corriander soup later, but serve as lunch material this week with left overs.

Like many, we’ve rolled off our fixed rate mortgage over the past couple of days just as the bite of winter hits the UK. We’ve had plenty of warning is coming – which allowed us to budget, so hopefully, we will not only be able to celebrate midwinters eve but have a happy new year.

Planning is everything, and I am not talking about pre-cooking the veggies on the day.

When you are sick, things happen to you and around you. I’d been to the doctor’s recently and went back home in a slightly worse state than I’d gone in because I still hadn’t been diagnosed. The locum GP thought I “didn’t look diabetic to [them]”.

Some people think you’re too young to remember what happened. This is what I remember.

Before.

I’d got sick in the summer, after finishing my second term at nursey school. School was great. I got sick very soon after the hoiday began. I spent a few days wrapped in blankets propped up on the sofa with my favourite rag doll. Part of me liked being that cocooned, though it was a bit boring.

By the time I went back after the summer, I was quieter and thirsty. The nursery assistant noticed I was now drinking the free milk – before the summer, I hadn’t touched it with a 10′ barge pole, now I was finishing it faster than anyone, even though I’d puked it back up shortly later a few times – I have never liked milk.

The walk to school was getting harder. Christmas was approaching. Father Christmases and mince pies. Sitting down as much as I could. Being asked to hurry up and mum putting me in my brother’s pram because that was quicker on longer walks.

I never wet the bed, I’m pretty good in the dark and the seat was down on the bathroom toilet, but the lid was up. Not a problem. We had a downstairs loo, so at home everything was dandy. A loo was never far away.

I remember sitting quietly a lot of the time but not sleeping. I’ve never been able to sleep when my blood sugar is high. The level where it is possible to sleep is now really quite low since I am in range so long. Over those weeks, the level must have been quite high.

We walked to the GPs. I remember the waiting room from visits for my family. There was a toy room with a rocking horse. That seemed like a lot of faff. I just sat on the big chair with mum while my kid brother played, we watched.

The lady was dark haired not Dr Smith. But the fish tank was there, tropical fish. I felt a bit brighter, a good sit down always helped. I watched the fish with my brother while mum spoke to the doctor. Mum was upset she wouldn’t test me.

Saturday and mum went to work as normal. I played with my brother in my room and went to bed after tea. The next morning, I peed into the beaker. Mum let me watch the colour change in the test tube when my urine was added, 15 drops and the big tablet was added. Then I was allowed to drink something. We had beef for lunch, when we visited my gran we’d get some of the beef my gran and granddad didn’t eat. No potato. Lot’s of gravy. Water only. I don’t remember tea. Normally it would be eggs and bread – my grandparents kept chickens, we ate a lot of boiled eggs for Sunday tea but I don’t remember that. I was hungry and ached, even walking across the lounge seemed like an awful lot of effort. Dad carried me to bed: I’d already had my bath.

The day.

Mum wanted me to wear the green dress I didn’t really like. We were taking dad to work. Then we drove out, away from home.

We parked and walked into the hospital. I just wanted to go home. Mum was a pharmacist, so she’d briefed me. The doctors would test me, then I’d have injections and they would make me better. It would mean injections, for always, but I would be better.

I remember waiting and being hungry and thirsty. Being four, I couldn’t tell the time and didn’t have much clue about the fact we were there all day. My dad didn’t have a telephone for personal use, so when we’d walked to the children’s ward, mum waited then spoke to the nurse – she’d be back and would take my brother so it was less effort, but she’d leave me and come back with my dad.

I was happy sitting. It was nice being quiet on the seat in the corridor between the young children’s rooms with the cribs and the main ward for the older kids. The treatment room was down the corridor, past the loos, I’d been once already.

The nurse asked me to go with her down to the treatment room. There was a picture of Rupert Bear on the door and a few other cut out cartoon figures, Mickey Mouse and Popeye. I don’t hold images in my memory, so I don’t remember if I don’t have the names of them. A filing cabinet and venetian blinds. A few nurses and a doctor, a young man with curly hair and a big moustache. He wanted me to look away while he set up a drip. I wasn’t asked to sit still, I was held.

In my brain, I think I was reasonably stating that wasn’t right, it was supposed to be an injection. My mum remembers it as me wailing. If you’ve ever read Calvin and Hobbes, think Calvin calmly expressing himself to his mum about why something should or shouldn’t be so – mum’s assessment is probably right.

The doctor took mum and dad outside, then mum came back in and said it would be OK. Once the drip was up, mum helped me undress and I wore a hospital gown, mum hadn’t thought I’d be kept in.

I was put in a crib which felt very unfair, I was a big girl and slept in a bed.

I watched the drip for a long while. I think my levels must have come down enough to allow me to sleep, so I did.

I didn’t know what day it was, other than a Monday – two days after mum went to work. I didn’t find out it was the 12th December, 1977. My diagnosis day.